FAQs

ADA

Does Sunflower coordinate with the other 2 MCOs on ADA accessibility surveys?

No, the ADA surveys are basic and nothing different than providers’ normal requirements.

Advance Directive

What are the provider's responsibilities related to Advance Directives for KanCare members?

Sunflower is committed to ensuring members are aware of and are able to avail themselves of their rights to execute Advance Directives. Sunflower is equally committed to ensuring participating providers and their staff are aware of and comply with federal and state laws regarding Advance Directives; and that the Sunflower Medical Management staff are trained on our policies and procedures related to Advance Directives.

PCPs and providers delivering care to Sunflower members must ensure members age 18 years and older receive information on Advance Directives and are informed of their right to execute an Advance Directive. Providers must document such information in the patient’s permanent medical record. See the Provider Manual for a list of recommendations for providers.

AuthentiCare

Sunflower requires an NPI number for billing. Will providers be able to continue to bill through AuthentiCare without the NPI number?

Yes. The State has provided current provider Medicaid ID numbers. These Medicaid ID numbers will be cross walked in the Sunflower claims system in order to match AuthentiCare claims without the NPI number.

Authorization

What services require Prior Authorization?

The services that require Prior Authorization can be found in the Provider Manual as well as posted in the Resources Section. Additionally, Sunflower offers a procedure lookup tool on our website. You can enter a CPT, HCPCs, or UB04 code to check for authorization requirements.

What criteria does Sunflower use to make authorization decisions?

Sunflower has adopted utilization review criteria developed by McKesson InterQual® products to determine medical necessity for healthcare services. InterQual appropriateness criteria are developed by specialists representing a national panel from community-based and academic practice.

InterQual is utilized as a screening guide and is not intended to be a substitute for practitioner judgment. The Medical Director, or other healthcare professional that has appropriate clinical expertise in treating the member’s condition or disease, reviews all potential adverse determination and will make a decision in accordance with currently accepted medical or healthcare practices, taking into account special circumstances of each case that may require deviation from the norm in the screening criteria.

Does a provider need prior authorization when Medicare is primary?

The member and provider are required to follow the rules of the primary payor. If the primary payor denies for administrative reasons, Sunflower will NOT coordinate with the primary insurance. If the primary payor denies for non-administrative reasons, the provider will be required to obtain an authorization for any service Sunflower would otherwise require an authorization if Sunflower had been the primary payor.

If a hospital participates in Sunflower's provider network, will the hospital's lab be contracted also; therefore, no Prior Authorization is needed for routine lab tests?

Yes.

Can LTC services be authorized online?

Yes.

Does the NIA authorization number need to be on the claim?

Yes.

Do dual eligibles require a Prior Authorization?

The member and provider are required to follow the rules of the primary payor. If the primary payor denies for administrative reasons, Sunflower will NOT coordinate with the primary insurance. If the primary payor denies for non-administrative reasons, the provider will be required to obtain an authorization for any service Sunflower Health Plan would otherwise require an authorization if we were the primary payor.

How long are Prior Authorizations valid for nursing facilities?

Is there a separate fax form for LTC authorizations?

No. Long Term Care centers should use the Inpatient Fax Form on the Sunflower website. There is a box to indicate that the site is a Long Term Care center.

Behavioral Health

Will Cenpatico post the new codes and payment schedule on their website for behavioral health providers?

Cenpatico will post a cross-walk to the new codes. This will be posted on the Cenpatico and Sunflower website. The actual fee schedule will not be posted.

Will Cenpatico post a Provider Manual?

The Manual is currently posted on both the Sunflower and Cenpatico websites.

Can a behavioral health provider submit claims through the Cenpatico website?

Yes.

How do behavioral health providers determine the total sessions per year for a Sunflower member?

Please refer to the Authorization Guidelines in the Cenpatico Provider Manual.

Can a provider determine a member's behavioral health coverage using the Cenpatico website?

Yes.

Are behavioral health claims submitted to Cenpatico?

Yes. Please see the Cenpatico Provider Manual for additional details.

Does Sunflower and Cenpatico have behavioral health education materials?

Yes. These materials are on the websites for both Sunflower and Cenpatico.

After a behavioral health provider submits claims through the secure portal, if the claim needs to be corrected, can this be done through the secure portal?

Yes, if you are a registered user on the Cenpatico secure provider portal.

Billing

How are providers informed of changes to billing processes?

Sunflower’s website displays all provider bulletins on the Provider Resources page. For immediate updates related to billing and claims payments, it’s important to sign up for the Email Alerts. Providers can subscribe to Sunflower’s email alerts through this website.

Should providers include the Rendering Provider Type 1 or Group Type 2 NPI?

How soon are claims be paid?

Sunflower has scheduled check runs two times a week. Our average claims payment turnaround time is 7 to 14 days for clean claims.

Does Sunflower accept Medicare crossover claims?

Yes.

If the NDC number is not included on claim, will the whole claim deny?

No, only that line item will deny.

Is the per diem rate the same for DME in LTC?

Yes.

Are nursing assessments and wellness monitoring covered?

Nursing assessments under the TA waiver have coverage of one (1) every three (3) months and the FE waiver one (1) per lifetime. Wellness monitoring has coverage for one (1) every fifty five (55) days under the FE waiver. These services require authorization.

Does Sunflower recover claim overpayments through a recoupment process?

Yes, unless the Provider’s contract specifies that overpayments should be handled in a different manner.

If a provider utilizes a billing clearinghouse that is not listed as one of the clearinghouses that Sunflower utilizes, can the provider continue to use their clearinghouse (example ASK)?

Yes, clearinghouses not on our list will route the claims to Avility which will send the claims on to Sunflower.

Do providers need a Kansas Medicaid ID number to be paid or to be contracted with Sunflower?

Generally no, however HCBS providers who submit claims via Authenticare do require a Kansas Medicaid ID number to use that system and to receive payment from Sunflower Health Plan. For assistance with obtaining an expedited Medicaid ID, please contact 1-877-644-4623 (TTY: 711) and follow the prompts to Provider Contracting.

Contracting

How do I become a contracted Provider in the Sunflower network?

Go to Contract Request Form. This form will ask you to complete some very basic information. You may also call us at 1-877-644-4623 (TTY: 711) to request a contract.

Do providers need a Kansas Medicaid ID number to be paid or to be contracted with Sunflower?

Generally no, however HCBS providers who submit claims via Authenticare do require a Kansas Medicaid ID number to use that system and to receive payment from Sunflower Health Plan. For assistance with obtaining an expedited Medicaid ID, please contact 1-877-644-4623 (TTY: 711) and follow the prompts to Provider Contracting.

Co-Pays

Will there be copays due by patients? With Sunflower? With other MCOs?

No, there are no co-pays for KanCare. However, some members have to cover a Spenddown requirement.

Credentialing

Does Sunflower credential ambulatory surgery centers (ASCs)?

Yes.

Do I have to be credentialed by Sunflower in order to become a contracted provider?

Yes, you must be credentialed by Sunflower. Upon your written authorization, Sunflower will access your credentialing information on the CAQH (Council for Affordable Quality Health) website. Sunflower will also use the Kansas Final Joint Approved Credentialing Application for hospitals and ancillary providers. These documents will be included in the contract packet sent to you by Sunflower.

DRG Audits of Hospitals

Our hospital's DRG claims are audited by iCRS; what do I need to know?

If I missed a Provider Seminar, can I still receive education?

How often can members change their MCOs and Providers?

Members can change their MCO during their 90 days of eligibility/assignment, then once/year during open enrollment. Members can change their PCP/providers at any time. To view Sunflower's provider directory, please click here.

Eligibility

Does Sunflower handle any dual eligibles?

Yes, only members under SSI, HCBS, and LTC.

When will newborns be assigned to an MCO?

Members are auto-assigned to MCOs by the State. Claims for newborn services billed under the mother’s beneficiary ID will be pended for 45 days pending receipt of the newborn’s beneficiary ID number. If a newborn ID is received, the claim will be denied EXnB – Deny: Rebill with Newborn Medicaid ID#, Name and DOB notifying the provider they must submit a corrected claim using the newborn’s ID number, name and DOB.

If no newborn ID is received and the date of service is within 45 days of the newborn’s date of birth, the claim may be paid using the mother’s ID number. If the date of service is not within 45 days of the newborn’s date of birth, the claim will be denied.

Are providers required to submit their weekly activity/care logs for HCBS services?

Health Homes

Health Plan

Who is Sunflower Health Plan?

Sunflower Health Plan is a Medicaid Managed Care Organization (MCO) contracted with the Kansas Department of Health and Environment (KDHE) – Division of Health Care Finance (DHCF) to serve Medicaid eligible members through the KanCare Program effective January 1, 2013.

Sunflower is a subsidiary of Centene Corporation which has over 27 years of experience in the Medicaid industry.

How will my office become familiar with the policies and procedures of Sunflower?

Upon completion of the contracting and credentialing process, you will be notified of your contract effective date and will receive a Provider Welcome Packet. This Packet will include a copy of the Provider Manual, the Billing Manual, Quick Reference Guides and other helpful forms.

Each office, hospital, clinic, and ancillary provider will be assigned a dedicated Provider Relations Specialist. Your Provider Relations Specialist will contact you to schedule an orientation to review the materials in the Provider Welcome Packet.

After my initial orientation, how will I be kept informed regarding Sunflower news?

Your Provider Relations Specialist will schedule periodic visits with you. In between the visits, you may visit this site for updates.

Additionally Sunflower has a local, dedicated Provider Call Center to assist you with any questions that you might have. The local Provider Services Representatives can be reached at 1-877-644-4623 (TTY: 711) Monday through Friday 8:00 a.m. to 5:00 p.m.

How do you register for PaySpan?

PaySpan will then send a test deposit to the bank account specified during the registration process. You must verify the receipt of the test deposit and then you will be fully registered. Electronic Remittance advice will begin immediately. If you have trouble with registration, please visit PaySpan's help page or contact your provider relations representative.

If a claim is submitted thru KMAP, can the provider be reimbursed through PaySpan?

Yes, if the provider is a registered user for PaySpan.

Will a behavioral health provider have to register with PaySpan for Sunflower and Cenpatico?

Yes, if the provider has signed both a Sunflower and Cenpatico agreement, the provider will need to register for both. Call PaySpan at 877-331-7154 to receive a registration code and PIN number in order to complete the registration process.

Referrals

Paper Referrals are not required for services at participating/contracted specialists. Members are educated to always consult with their Primary Care Physician before accessing specialty services.

Secure Portal

How will I know if a patient is a Sunflower member?

Member Identification cards will be issued to all Sunflower members. Sunflower strongly encourages you to verify eligibility each and every visit. Eligibility can be verified through the Sunflower Secure Web Portal or by calling Provider Services at 1-877-644-4623 (TTY: 711). Additionally, eligibility may be accessed via the KMAP website.